MetroHealth urges Cuyahoga County to maintain $35 million subsidy as charity care soars

Christine Alexander Rager, president and CEO of the MetroHealth system, told the Cuyahoga County Committee of the Whole on Nov. 10 that the public hospital is facing unprecedented financial pressure and asked council to maintain its current county subsidy of $35,000,000.

MetroHealth is tracking a steep increase in uncompensated and charity care: Alexander said the system was on track to end the year with about $367,000,000 in uncompensated care and that charity care could rise to about $446,000,000 in 2026. Operating revenue and expenses for the system each exceed $2 billion, and MetroHealth projects a roughly $31,000,000 operating loss for the year, she said. A capital plan for 2026 was shown at about $72,000,000.

"We have a request of you," Alexander told the committee. "Actually, we have a few. But the first request is that our current subsidy be maintained at $35,000,000." She explained the system has taken steps to reduce costs — a hiring freeze, a reduction in force and consolidation of clinics — and is seeking new revenue streams and partnerships to stabilize operations.

Council members pressed MetroHealth on the components of its uncompensated-care figures and on an announced closure of a psychiatric emergency room at one campus. Alexander distinguished the psychiatric emergency room that is being de‑staffed from the separate behavioral health hospital on the same campus, saying the emergency room was not sustainable without certain external funding and that staff will be redeployed to other emergency departments and outpatient sites.

Council members voiced concern about both the clinical impacts and the county'wide implications of shifting behavioral-health capacity. Councilman Gallagher said he believed MetroHealth had been unfairly portrayed in media coverage and criticized decisions by other local funders; in the hearing he asserted "I smell a rat" about the sequence of funding moves and said he would pursue further review. Alexander responded that decisions to change service lines were driven by funding shortfalls and broader cost pressures, including projected federal changes to Medicaid and Medicare.

Alexander also highlighted an outpatient health center expected to open in 2026, a 300,000-square-foot facility intended to expand outpatient capacity and include a 24/7 drive-through pharmacy.

The presentation and exchanges did not produce a formal county action during the hearing; MetroHealth's requests will be considered as council reviews the executive's biennial budget resolution.

Next steps: council members said they would continue budget deliberations during the committee process and that amendments or restorations to the executive's proposed numbers could be introduced before final adoption.